Understanding clinical features, predictors of late presentation, and caregiver perspectives and awareness of strabismus in children: a cross-sectional study in a sub-Saharan African setting.

BACKGROUND: Childhood strabismus is a common eye disorder with visual and psychosocial implications. Late presentation remains frequent, influenced by clinical and demographic factors, as well as caregiver knowledge, awareness, and perceptions in sub-Saharan Africa. This study sought to analyze the clinical features, predictors of late presentation, and caregiver perspectives and awareness of strabismus among children attending the Eye Department at Komfo Anokye Teaching Hospital. MATERIALS AND METHODS: A hospital-based analytical cross-sectional study was conducted on 282 children aged 3-15 years. Data on the demographic and clinical characteristics of the participants were analyzed using SPSS Version 20. The chi-square test was used to examine the associations between late presentation and demographic and clinical features. Logistic regression analysis was used to analyze the predictors of late presentation of strabismus, with odds ratios (ORs) and 95% confidence intervals (CIs) calculated. Statistical significance was set at P < 0.05. RESULTS: The study included 282 children with strabismus, with a mean age at onset of 4.0 ± 1.2 years and a mean age at presentation of 10.1 ± 9.4 years. The majority (148/282, 54.5%) were males. There was a predominance of a left eye deviation (166/282, 58.9%); esotropia predominated (204/282, 72.3%), with 50% inward deviation, 83.3% constant deviation, and 85.5% equal vision in both eyes. 83% of patients presented late. Predictors of late presentation were: having no knowledge about strabismus (p = 0.01, OR = 2.6, CI: 1.3-5.5), low parental education (p = 0.013, OR = 2.3, CI: 1.2-4.4), and having no relative with strabismus (p = 0.003, OR = 3.7, CI: 1.5-8.6). Most parents (189/282, 67.30%) were aware of strabismus, with hospitals being the main source of information (87/189, 46.0%). While 133/282 (47.2%) believed that it was treatable, 149/282 (52.8%) held misperceptions. CONCLUSIONS: Esotropia was the most common type of strabismus, with left eye deviation being the most prevalent. Having no knowledge about strabismus, low parental education, and having no relative with strabismus predicted late presentation. Even with caregiver awareness, misperceptions persisted, highlighting the need to strengthen public education and early intervention strategies. CLINICAL TRIAL NUMBER: Not applicable.